Federal Law Enforcement Break Up Huge Medicare Fraud Ring

Federal prosecutors recently charged 73 people, from Georgia to California, for allegedly defrauding Medicare out of $163 million, according to an article on Foxnews.com. The people arrested were apparently setting up fake doctor-patient relationships and billing Medicare for medical services that were never performed. More traditional Medicare fraud involves doctors or other medical professionals billing Medicare for medical services that are not necessary or never performed and medical devices that are not needed or used by the patient. However, in this case, the suspects apparently made up the whole thing. They are reported to have used stolen social security numbers and identification information to create patient accounts. They also allegedly used stolen identification information from doctors to make it seem like the facilities had actual doctors ordering the medical services and devices. Phantom medical facilities were also created where the fictitious patient visits were supposed to take place.

The authorities were alerted to this scheme when they matched up a large number of the social security numbers on the Medicare reimbursement forms with the social security numbers of Medicare patients who reported having their identification information stolen. In addition to that evidence, the Medicare reimbursement forms also showed that some of the medical treatment for which reimbursement under Medicare was requested, was ordered by the wrong kind of doctor. As an example, the article notes that the suspects asked Medicare for reimbursement for a pregnancy ultrasound performed by an ear, nose and throat doctor.